ABDOMINAL SURGERY IN PATIENTS ON MAINTENANCE HEMODIALYSIS DUE TO CHRONIC RENAL FAILURE II

A total of 88 patients on maintenance hemodialysis due to chronic renal failure underwent laparotomy during the 18-year period from September 1971 to August 1989. Of these patients, 62 received an operation in the first 13-year period (group 1) and 26 in the second five-year period (group 2). Comparison of the groups showed that the mean age of group 2 (50.6 years) was older than that of group 1 (43.5 years). Both incidences of emergency operation and postoperative death increased in group 2 (32.3% vs 57.6% and 16.9% vs 19.2% respectively). The profile of diseases treated by surgery differed between the groups. The incidence of small and large bowel diseases increased in group 2, and these patients had a high incidence of emergency operations.In order to assess the correlations between various preoperative factors and postoperative death, 14 factors were analyzed in group 2. Emergency operation, shock, gastrointestinal bleeding and abnormalities of cardiac function were found to correlated significantly with postoperative death. When these risk factors were expressed as scores for the individual patients, the death rate was 0% for patients with a score of less than four. However, the fatality rate reached 100% for patients with a score of seven or more.